What are overuse injuries?

With the London marathon and Manchester 10km now begining to loom on the horizon we have seen the  familiar increase in overuse type injuries  here at JUMP Physio. These have been especially in but not limited to to the running population. The inevitable question always arises. What causes over use injuries? Well, without stating the obvious it is usually a combination of factors such as the training load, the biomechanics of the movement and physiological state of the tissue.   Needless to say here at JUMP Physio we don’t see athletes with excellent biomechanics, normal tissue and subjected to appropriate training load  presenting themselves in the clinic. We do however see a whole bunch of frustrated people of all abilities presenting with one or more of the above  contributory factors. Such as the runner who has gradually being building up their mileage with appropriate recovery periods, developing shin splints, anterior knee pain, achilles tendinopathy or ITB problems due to altered mechanics caused by tight calves or weak glutes.  We also see people with optimal mechanics, present with similar injuries because of inappropriate loading or lack of recovery between runs.

Every time you exercise your tissues are loaded causing physiological change and structural adaptation. In running or with any other  training stimulus this can lead to muscle hypertrophy, thickening of bones, enhancement of neural pathway’s, the strengthening of tendons. These changes take time however and before all these positive adaptations occur the short term effects of training are that tissues fatigue and become less resilient to load. Continuing to apply load to these tissues increases the risks  associated with tissue break down and injury.

Management of these injuries therefore focuses on addressing the relevant biomechanical faults, identifyng the state of the underlying tissue and prescribing a suitable load and recovery plan. Of course it also helps if you understand what has caused the injury so it doesn’t happen again.

The run at Clearwater

If you feel like you may have over done the training or can’t figure out why your body hurts so much after an easy run give us a call at JUMP Physio to see if we can help.

ITB friction Syndrome

With marathon and triathlon season started we are seeing more and more running related injuries at JUMP Sports Injury Clinic. By far the most common type of running injury/ sports injury we see is an over load injury to the Ilio Tibial Band (ITB) called ITB friction syndrome. Here is a brief discription of the injury and some common causes.

The Ilio Tibial Band  (ITB ) is a thickened band of connective tissue  that runs down the outside of the thigh. As the knee flexes and extends the ITB glides over the lateral femoral condyle, a bony prominence.

If the load across the ITB is increased the point where the ITB runs over the femoral condyle can become inflammed leading to pain and to what is commonly called ITB friction syndrome.

ITB Syndrome commonly presents with the following symptoms.

  • A dull ache on the outside of the knee that increases during a run gradually getting worse for the duration of the run., Pain is often worse the next morning. It can be aggravated further by running downhill, on cambered surfaces or walking downstairs.

ITB friction syndrome is an over use injury with several proposed potential contributory factors.

  • Run technique: Stride length has been proposed to affect both the size of knee bend and thus the load across the ITB. Excessive stride length seems to aggravate the ITB where as pain is often reduced when the length of the stride is reduced.
  • A tight ITB as measured by the Ober’s Test is thought to be a contributory factor to ITB friction syndrome.
  • Training Error: As with all over load injuries doing too much of a particular type of training places excessive loads across the joints. Even if cardiovascularly you feel fine you need to gradually build up your training. What is too many miles unfortunately depends on the individual. In clinic the most common training error we see are runners running the same route 3 times a week at the same pace and gradually increasing the times spent running. If you run the same route night after night at the same pace you are loading your joints muscles in the same way on the same surface night after night. Try varying the length of your runs, the speed of your session and the terrain you run on. 
  • Anything that causes the knee to track medially (towards the mid line of your body loads the ITB. This increases the load over the femoral condyle. Various bio mechanical reasons can cause your knee to drop medially
  1. Weak Hip Abductors. The muscles on the side of your pelvis namely the gluteus medius muscles help control your pelvis when you run.  When you lift your left leg off the ground your right gluteus medius muscle contracts and stabilises the pelvis keeping it level. When your gluteus medius muscles are weak the left side of you pelvis drops and the right knee is pulled across the midline as run. This is repeated endlessly as you run.

Reference : http://www.physio-optima.ca/bibliotheque/bit.pdf

  1. Over pronation of the feet. Feet that over pronate on impact cause the knee to follow the foot and drop medially. By far the most common and correctable cause of over pronation in runners are tight calves.

 

Treatment

  • Have yourself assessed by a chartered Physiotherapist who can diagnose the problem, identify your unique contributory factors and get you back on the road to recovery.
  • Rest from running until the inflammation decreases.
  • Avoid downhill running and running on cambered surfaces.
  • Speak to your pharmacist. Take a course (5 – 7 days) of non-steroidal anti-inflammatory drugs.
  • Apply ice to the knee (for 20minutes every evening ) in order to reduce the inflammation
  • Self-massage/ stretching on a foam roller
  • Remember to stretch well before running
  • Address any training errors

 

Recovery: Time to full recovery depends on the extent and cause of the injury. But a general rule is the earlier you address the problem the quicker you’ll recover.

Preventative measures:

  • Regular stretching of the ITB, quadriceps, hamstring, and gluteal muscles.
  • Gradual progression of training program
  • Avoid excessive downhill running, and cambered roads (stay on the flattest part of the road)
  • Working on run efficiency and stride efficiency.
  • Build some regular core strengthening exercises such as Pilates into your routine.
  • Regular sports massage

Fore Foot Running

Following the first JUMP Physio run clinic last week, people have asked for more information on forefoot running and barefoot running. I’ve found and attached the following videos that help explain the reasoning behind forefoot running and its possible relationship with a decrease in running injuries. Our sports physiotherapist will be advertising dates for the next run clinic shortly through this blog.

http://www.youtube.com/watch?v=1fBh2qH4QbM

http://www.youtube.com/watch?v=7jrnj-7YKZE

Running injury Free

Whether you just run to stay fit or you’ve just signed up for one of the big races like the Manchester great run in May or the London Marathon there is nothing more annoying than having your training interrupted by injury  and enforced rest. Knowing a little bit about how to train and what signs to look out for can save you months of discomfort.

The majority of running injuries are caused by overloading to the joints and muscles. Here is a brief list of injury prevention tips to help you run injury free.

1)      The 10% rule. Try not to increase your distance more than 10% per week. Your heart and lungs adjust to stress quicker than the joints so even if you feel ok increase your distances slowly.

2)      Ice aches and pains as soon as you get back. When you do injure yourself the majority of the discomfort is caused by swelling. Minimise the swelling and speed your recovery  by icing immediately for 20 minutes

3)      There is currently lots of debate on the optimal amount of support a runner should have for their feet as they run. We don’t have time to expand the argument for and against but the simple advice is if you are new to running or increasing your distances  it is a good idea to invest in actual running shoes from a specialist running shop and replace them as the support decreases. Running in unsuitable trainers places unnecessary load on your ankles knees and hips if you are not used to running.

4)      Mix-up your training plan. No matter what level of runner you are, running the same route at the same pace every night will not make you any faster or fitter after your initial improvement. Repetition will however give you sore joints and muscles. Your training should include long runs and short runs, slow runs and faster runs.

5)    Perform a good stretching programme before and after exercise.

6)    If your pain is not going away don’t try to run through it consult a sports physiotherapist.

If you have any questions on running injuries feel free to e-mail me for some advice on kieran@jumpphysio.com

The Running Clinic

 

Last night JUMP Physio in association  with Pro Balance Personal Training Gym held the first running clinic at the pro Balance Gym on Jacksons Row.  The idea of the running clinic is to identify potential problems in runners by doing a short video analysis on the treadmill followed by some muscle length tests on the plinth. Although by no means a fully in-depth analysis  (last night we averaged about 15 minutes with each runner) everyone I think got some valuable advice on areas to work on over the next few weeks and hopefully some tips to take away to prevent further running injuries

There were no surprises on the night with the most common weaknesses in the running population all making an appearance. These included weak gluteus medius muscles, tight Iliotibial Bands (ITB), tight gastrocnemius muscles and poor lumbo pelvic control. Although nobody turned up last night complaining of pain or injury we still found quite a few asymmetries in running gait and some large muscle imbalances.  Thanks to Andy Jeffries on the night for explaining and demonstrating the corrective exercises with the runners.   

I’ll send out a pdf with those exercises  Andy Jeffries went through last night during the week to everyone who attended. We hope to run a similar clinic again over the next few weeks.